Laparoscopic extralevator abdominoperineal resection for low rectal cancer: The myth of reinventing the wheel.

Background & Objective: To review oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer.In locally advanced low rectal cancer, ELAPE which is en-bloc resection of levator muscles along with the tumor in a prone position has significantly decreased the rate of having either positive circumferential resection margin (CRM) or tumor perforation. The aim of the study was to determine the oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer. Methods: This retrospective study was performed at Shaukat Khanum Cancer Hospital and Research Centre Lahore. Patients who underwent ELAPE for low rectal and anal cancer from January 2014 to December 2019 were selected. Data was collected using an electronic database through a hospital information system. Results: A total of 82 patients were included in the study having a median age of 39 years. Clinically preoperative tumor sizes were T2:2, T3:65, T4:15. Neo-adjuvant chemo radiotherapy was administered to 79 (96.3%) patients. Pathologically tumor sizes were T0:12, T2:15, T3:50, T4:5 with 79.2% (n=65) R0 resections. The mean operative time was 340.36±64.51 minutes and the mean blood loss was 99 milliliters. The mean postoperative hospital stay was 6.58±4.64 days. Seventeen (20.7%) cases had pathological circumferential resection margins positive (pCRM<1mm). However, tumor perforation was found in 8(9.8%) patients. Ninety days mortality was none while 36 patients experienced recurrence (local: 23, distant: 30, local + distant 17). The median survival time was 53.00±2.69 months. Conclusion: For locally advanced low rectal cancer, ELAPE has evolved as a safe oncological procedure with acceptable outcomes.

Prevalence of BRCA1 and BRCA2 germline variants in an unselected pancreatic cancer patient cohort in Pakistan.

BACKGROUND: BRCA1 and BRCA2 (BRCA1/2) are the most frequently investigated genes among Caucasian pancreatic cancer patients, whereas limited reports are available among Asians. We aimed to investigate the prevalence of BRCA1/2 germline variants in Pakistani pancreatic cancer patients. METHODS: One hundred and fifty unselected and prospectively enrolled pancreatic cancer patients were comprehensively screened for BRCA1/2 germline variants using denaturing high-performance liquid chromatography and high-resolution melting analyses, followed by DNA sequencing of the variant fragments. The novel variants were analyzed for their pathogenic effect using in-silico tools. Potentially functional variants were further screened in 200 cancer-free controls. RESULTS: Protein truncating variant was detected in BRCA2 only, with a prevalence of 0.7% (1/150). A frameshift BRCA2 variant (p.Asp946Ilefs*14) was identified in a 71-year-old male patient of Pathan ethnicity, with a family history of abdominal cancer. Additionally, we found a novel variant in BRCA2 (p.Glu2650Gln), two previously reported variants in BRCA1 (p.Thr293Ser) and BRCA2 (p.Ile2296Leu) and a recurrent nonsense variant in BRCA2 (p.Lys3326Ter). These variants were classified as variants of uncertain significance (VUS). It is noteworthy that none of these VUS carriers had a family history of pancreatic or other cancers. CONCLUSIONS: In this first study, BRCA1/2 pathogenic variant is identified with a low frequency in pancreatic cancer patients from Pakistan. Comprehensive multigene panel testing is recommended in the Pakistani pancreatic cancer patients to enhance genetic understanding in this population.

Rectosigmoid resection morbidity in ovarian cancer cytoreductive surgery.

This case series evaluated morbidity following rectosigmoid resection during cytoreductive surgery for advanced ovarian cancer at the Shaukat Khanum Memorial Cancer Hospital, Lahore. The data of 20 female patients with complications corresponding to the Clavien-Dindo classification was included; the patients received treatment between January 2016 and January 2021. The mean age was 45.05± 13.11 years. Complications were observed in 3 (15.0%) cases, i.e., urinary complications in 2 (66.7%), and intra-abdominal abscess in 1 (33.3%) case. Clavien-Dindo classification grade II was noted in 2 (66.7%), while grade III-B in 1 (33.3%) case. Surgical risk factors were noted as appendectomy in 6 (66.7%) cases, bowel resection in 1 (11.1%), left colectomy in 1 (11.1%), sigmoid colectomy in 1 (11.1%), and stoma formation in 11 (55.0%) cases. In this reported case series, significant complications were observed in women undergoing rectosigmoid resection as cytoreductive surgery for advanced ovarian cancer.

Emergency esophagectomy: Experience of a high volume esophageal cancer center.

Objective: The objective of the study was to review the experience of dealing oncological emergency esophagectomies at a dedicated Cancer hospital. Methods: We performed a retrospective review of data of eleven esophagectomies at the Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (SKMCH&RC) Pakistan, from 1st January, 2009 to 30th June, 2019. Out of 590 oncological esophagectomies, eleven patients had emergency resection. We collected the data of demographics, primary disease, comorbidities, location of tumor and perforation, cause of perforations, radiological and endoscopic findings, clinical findings and follow-up visits after discharge. Data was analyzed by SPSS version 21 for windows. Result: All 11 patients out of five hunded ninety had esophageal cancer. At the time of initial staging, eight (72%) had locally advanced stage (stage III and IV). Open transhiatal approach was used in six (55%) patients, and the rest had three stage esophagectomies. Primary reconstructions with gastric conduit were performed in all, except in two (18%) patients, Respiratory complications were the most common of the encountered complications, seven (63%) of the patients had palliative resection. Ninety day mortality was observed in 3(27.3%) patients. On long term follow up, six patients had recurrence, with median Disease-Free Survival (DFS) 5.88 months and Median Overall Survival (OS) was 6.37 months. Out of 11, only three patients are alive without disease, while one patient is lost during follow-up. Conclusion: Emergency esophagectomy is a lifesaving procedure; there should be multidisciplinary team approach towards the management. Early diagnosis and management is of paramount importance.

Is age just a number or does it really affect the surgical and oncological outcomes after pancreatoduodenectomy?

OBJECTIVE: To review the impact of age on perioperative and postoperative outcomes in patients following pancreaticoduodenectomy. METHODS: The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2014 to December 2018 of all patients who underwent pancreatoduodenectomy. Postoperative morbidity and oncological outcomes were compared between patients aged ≤60 years in group A and those aged >60 years in group B. Data was analysed using SPSS 20. RESULTS: Of the 161 patients, 103(64%) were males and 58(36%) were females. There were 117(73%) patients in group A; 72(61.5%) males and 45(38.5%) females with an overall mean age of 46±11 years. The remaining 44(27%) were in group B; 31(70.5%) males and 13(29.5%) females with an overall mean age of 67±05 years. The most common pathology was adenocarcinoma 130(81%), commonest site was periampullary 85(53%) and the most common pancreatic reconstruction technique employed was pancreaticogastrostomy 110(68%). Patients in group B had significantly higher comorbidities compared to those in group A (p<0.05). Estimated blood loss during surgery was significantly higher in group B (p=0.004). There was no significant difference in overall morbidity (p=0.856), reoperation (p=1.000), 30-day readmission rate (p=0.097), 90-day mortality rate (p=0.324)) and overall survival (p=0.551) between the groups. CONCLUSIONS: Pancreatoduodenectomy could be performed in the elderly with comparable morbidity and oncological outcomes as younger patients. Comorbid conditions remained higher in elderly patients and preoperative optimisation may help improve postoperative outcomes.

Retrospective study of ovarian malignancy managed in surgical unit at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore.

OBJECTIVE: To determine the oncological outcome and pattern of ovarian tumours in patients who underwent surgical management. METHODS: The retrospective, descriptive hospital-based study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of all patients who underwent surgical intervention for ovarian cancer between January 2010 and December 2015. Data was retrieved from the hospital database and analysed using SPSS 20. RESULTS: Of the 236 patients, 203(86%) had undergone open surgery, while 33(14%) had had laparoscopic surgery. Neo-adjuvant chemotherapy was given in 60(25.42%) cases and adjuvant chemotherapy in 102(43.22%). Epithelial ovarian cancer in 201(85.16%) cases was the most common tumour type. Mortality was recorded in 36(15.5%) cases, while 41(19.9%) were lost to follow-up. CONCLUSIONS: Ovarian tumours were found to be difficult to treat and were associated with frequent recurrence.

Clinical Practice Guidelines For The Management Of Colorectal Cancer, A Consensus Statement By The Society Of Surgeons® And Surgical Oncology Society Of Pakistan®.

A joint effort by the Society of Surgeons Pakistan and Society of Surgical Oncology Pakistan, these guidelines provide a framework for the practicing surgeons involved in care and management of patients with colorectal cancer. The guidelines take into account the issues related to our local circumstances and provide a minimum standard of care that must be given to these patients. The Guideline Committee had members from all disciplines, including surgery, surgical oncology, medical oncology and radiation oncology. The guidelines have attempted to simplify things to understand and follow for the practicing surgeons. With these guidelines we wish to eliminate disparities in treatment among institutions and prevent any under treatment of patients.

Pancreaticoduodenectomy: Outcomes of a complex surgical procedure from a developing country.

BACKGROUND: Pancreaticoduodenectomy (PD) plays an integral part in the management of pancreatic, periampullary and duodenal cancers, along with a few other pathologies of this region. Despite advances in surgery PD continues to have significant morbidity and noteworthy mortality. The aim of this study is to provide an in-depth report on the patient characteristics, indications and the outcomes of PD) in a tertiary cancer hospital in Pakistan. MATERIALS AND METHODS: The study population included patients who underwent PD between January 1, 2014 and march 31, 2019, at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) in Pakistan. The data was retrospectively analyzed from the Hospital Information System (HIS), which is a prospectively maintained patient electronic database of SKMCH&RC. Patient characteristics, procedural details and post-operative outcomes according to internationally accepted definitions were reported. RESULTS: A total of 161 patients underwent PD at our hospital in the study period at a median age of 53 years, ranging from 19 to 78 years. 62% of the patients were males while 37% were females. Jaundice was the most common presenting symptom (64.6%), followed by abdominal pain (26.7%). PD with pancreaticogastrostomy was performed in 110 patients (68.3%), while pancreaticojejunostomy was performed in the rest of the cohort. Surgical site infection (SSI) was observed in 64 patients (40%). The incidence of Pancreatic Fistula grade C based on the International Study Group on Pancreatic Fistula (ISGPF) definition was 7.45% (n = 12). The 30 days mortality rate was 3.1%. Median survival of the cohort was 21 ±1.13 months and disease-free survival was 16±2.62 months. CONCLUSION: PD can be performed with acceptable morbidity and mortality in a resource constrained country, as long as it is undertaken in a high-volume center. This is in keeping with data published from other well-reputed international centers.

Hepatic arterial system anomalies encountered during pancreaticoduodenectomy - our experience.

We present our experience of incidence and management of aberrant hepatic arterial anatomy encountered during pancreaticoduodenectomy (PD). Patients undergoing PD between December 2014 and November 2016 at the Shaukat Khanum Memorial Cancer Hospital, Lahore were included in this short report. Preoperative imaging and operative findings of these patients were reviewed to evaluate the hepatic arterial anatomy and classified according to Hiatt classification. Sixty-four PD were performed with aberrant arterial anatomy identified in 24 (37.5%) of the cases. Most common anomaly was replaced right hepatic artery (rRHA) arising from the superior mesenteric artery seen in seven (11%) of the patients. Aberrant vessels were recognised and preserved in 23 cases. In one patient, the rRHA was coursing through the pancreatic parenchyma needing resection and reconstruction with uneventful postoperative recovery. Hepatic arterial anomalies are common and it is possible to preserve these vessels with careful surgical dissection using artery first technique.

A retrospective study of endometrial stromal sarcoma: an institutional review.

This is a retrospective study conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, from January 1995 to April 2016, to determine the clinical presentations, pathological features, cancer free survival and rate of recurrence in patients with Endometrial Stromal Sarcoma (ESS). Data was collected from May to August 2017. A total of 31 patients with a mean age of 40.0±11.72 years were treated. Among them, 12 (38.7%) had stage I, 2 (6.4%) had stage II, 6 (19.3%) had stage III and 11 (35.5%) had stage IV ESS. All patients underwent surgical management as an initial treatment modality for ESS. Out of these 31 patients, 17 were under active surveillance, 4 had expired and 10 patients were lost to follow up. Eleven (65%) patients were disease free, recurrence was noted in 4 (23.5%) patients and 2 (12%) patients had persistent disease. Recurrence of disease was managed with surgical excision and multimodality treatment. Median duration of follow-up was 38.29 months. Endometrial stromal sarcoma (ESS) is a rare uterine tumour. Our patients were young and had lower rate of recurrence. Surgical management was the mainstay of treatment in patients with resectable disease while other options used included hormonal therapy, radio therapy or chemotherapy.

Proteomics analysis of colon cancer progression.

BACKGROUND: The aim of this pilot study was to identify proteins associated with advancement of colon cancer (CC). METHODS: A quantitative proteomics approach was used to determine the global changes in the proteome of primary colon cancer from patients with non-cancer normal colon (NC), non-adenomatous colon polyp (NAP), non-metastatic tumor (CC NM) and metastatic tumor (CC M) tissues, to identify up- and down-regulated proteins. Total protein was extracted from each biopsy, trypsin-digested, iTRAQ-labeled and the resulting peptides separated using strong cation exchange (SCX) and reverse-phase (RP) chromatography on-line to electrospray ionization mass spectrometry (ESI-MS). RESULTS: Database searching of the MS/MS data resulted in the identification of 2777 proteins which were clustered into groups associated with disease progression. Proteins which were changed in all disease stages including benign, and hence indicative of the earliest molecular perturbations, were strongly associated with spliceosomal activity, cell cycle division, and stromal and cytoskeleton disruption reflecting increased proliferation and expansion into the surrounding healthy tissue. Those proteins changed in cancer stages but not in benign, were linked to inflammation/immune response, loss of cell adhesion, mitochondrial function and autophagy, demonstrating early evidence of cells within the nutrient-poor solid mass either undergoing cell death or adjusting for survival. Caveolin-1, which decreased and Matrix metalloproteinase-9, which increased through the three disease stages compared to normal tissue, was selected to validate the proteomics results, but significant patient-to-patient variation obfuscated interpretation so corroborated the contradictory observations made by others. CONCLUSION: Nevertheless, the study has provided significant insights into CC stage progression for further investigation.

Prognostic significance of pre- and post-operative serum carcinoembryonic antigen levels in patients presented with rectal carcinoma; an experience from Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore.

OBJECTIVE: To explore the importance of serum carcinoembryonic antigen level as a tumour marker in rectal carcinoma. METHODS: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of patients with rectal carcinoma from January 1996 to December 2015. Serum carcinoembryonic antigen levels were analysed using immulite@2000 system analyser. On the basis of serum carcinoembryonic antigen levels, data of patients was divided into four groups. Group A had normal serum levels both before and after surgical resection; Group B had normal levels pre-surgery but post-surgery levels were raised; Group C had raised levels pre-surgery that went down to normal post-surgery; and Group D had raised levels both before and after surgery. SPSS 23 was used for data analysis. RESULTS: Of the 401 patients, 267(66.6%) were males, and 204(50.9%) were aged <50 years. Group A had 267(66.6%) patients, Group B 26(6.5%), Group C 79(`9.7) and Group D had 29(7.2%) patients. Stage III disease was the most common 343(85.5%) and it was true across the groups. Overall recurrence was in 141(35.2%) patients. Group D had the highest recurrence rate 26(89.7%), while Group C had the lowest 18(22.8%). CONCLUSIONS: Fluctuating levels of carcinoembryonic antigen affected post-operative outcome.

Morbidity analysis in minimally invasive esophagectomy for oesophageal cancer versus conventional over the last 10 years, a single institution experience.

BACKGROUND: There has been an increasing inclination towards minimally invasive esophagectomies (MIEs) at our institute recently for resectable oesophageal cancer. OBJECTIVES: The purpose of the present study is to report peri-operative and long-term procedure specific outcomes of the two groups and analyse their changing pattern at our institute. METHODS: All adult patients with a diagnosis of oesophageal cancer managed at our institute from 2005 to 2015 were included in this retrospective study. Patients' demographic and clinical characteristics were recorded through our hospital information system. The cohort of esophagectomies was allocated into two groups, conventional open esophagectomy (OE) or total laparoscopic MIE; hybrid esophagectomies were taken as a separate group. The short-term outcome measures are an operative time in minutes, length of hospital and Intensive Care Unit (ICU) stay in days, post-operative complications and 30 days in-hospital mortality. Complications are graded according to the Clavien-Dindo classification system. Long-term outcomes are long-term procedure related complications over a minimum follow-up of 1 year. Trends were analysed by visually inspecting the graphic plots for mean number of events in each group each year. RESULTS: Our results showed no difference in mortality, length of hospital and ICU stays and incidence of major complications between three groups on uni- and multi-variate analysis (P > 0.05). The operative time was significantly longer in MIE group (odds ratio [OR]: 1.66, confidence interval [CI]: 2.4-11.5). The incidence of long-term complication was low for MIE (OR: 1.0, CI: 133-1.017). However, all post-operative surgical outcomes trended to improve in both groups over the course of this study and stayed better for MIE group except for the operative time. CONCLUSION: MIE has overall comparable surgical outcomes to its conventional counterpart. Furthermore, the peri-operative outcomes tend to improve in our centre with the maturation of program and experience.

Does prior percutaneous endoscopic gastrostomy alter post-operative outcome after esophagectomy.

BACKGROUND: With the introduction of neoadjuvant chemoradiotherapy in patients with esophageal carcinoma, nutritional access has become essential to counter deleterious effects of dysphagia. Current NCCN guidelines do not recommend PEG prior to esophagectomy in these patients, but there is little evidence for this recommendation. The objective of this study was to compare outcomes in patients who underwent esophagectomy with or without prior PEG placement. METHODS: We retrospectively reviewed 96 patients who underwent esophagectomy between 2005 and 2012 for esophageal carcinoma. Patients were divided into two groups; Group I (PEG +ve) and Group II (PEG -ve). Patient characteristics, operative variables, and post-operative complications were compared. χ (2) and Fisher's test were used for categorical, while t test was used for interval variables. RESULTS: Median age was 51(18-70) years. Lower thoracic tumors were more common in Group I (69 vs. 63 %) (P = 0.04) and more patients underwent minimally invasive surgery in this group (50 vs. 2.6 %) (P < 0.0001). Mean blood loss (326 vs. 465 ml) (P = 0.02) and ICU stay (1.6 vs. 4.3 days) (P = 0.01) were significantly lower in Group I. There was no 30-day mortality in Group I versus 10.5 % in Group II (P = 0.01). No significant difference in anastomotic leak and stricture rate was observed. Gastric conduit was used in all patients for reconstruction. One patient had malignancy in PEG site biopsy. CONCLUSION: Percutaneous endoscopic gastrostomy before esophagectomy is safe and does not adversely impact post-operative outcomes.

METASTATIC RADIOIODINE AVID STRUMA OVARII ASSOCIATED WITH PSEUDO-MEIGS' SYNDROME.

We report a case of 21 years old lady who presented with ascites, left adnexal mass and elevated CA-125. With suspicion of ovarian malignancy, she underwent left salpingo-oophorectomy with omental biopsy. Histopathology revealed: 'follicular variant of papillary thyroid carcinoma arising in struma ovarii' with metastatic papillary thyroid carcinoma in omental and peritoneal nodules. Patient underwent total thyroidectomy followed by radioactive iodine therapy for metastatic omental and peritoneal disease. Post-therapy whole body scan, revealed extensive I-131 avid disease metastatic disease involving the chest, abdomen, pelvis and the musculoskeletal system. Patient was treated with multiple doses of high dose radioactive iodine. She became symptom free on supra-physiologic doses of oral thyroxin however her high thyroglobulin levels and residual radioiodine avid metastatic disease required further treatment. In literature a few cases of struma ovarii have been reported with elevated CA-125 and associated pseudo-Meigs' syndrome. The treatment for this rare disease is still not standardized and poses a therapeutic challenge. Our case emphasizes the need for a multidisciplinary approach for managing struma ovarii.

Pancreaticoduodenal resection for malignancy in a low-volume center: long-term outcomes from a developing country.

BACKGROUND: The technical complexity of pancreatic resection has made it a specialized procedure performed in high-volume centers. It has been shown that patients operated on in high-volume pancreatobiliary centers have fewer complications and better survival. The purpose of this study was to share our experience with and report long-term outcomes of pancreaticoduodenal resections performed in a low-volume center in Pakistan. METHODS: Data of patients who underwent pancreaticoduodenal resection for adenocarcinoma at our institute from 1999 to 2012 were reviewed. A total of 39 patients were included in the study. Variables included patients' clinical and histopathological characteristics. Outcome was determined based on complication rate, 30- and 90-day mortality, disease-free survival, and overall survival. For survival analysis, Kaplan-Meier curves were used and significance was determined using a log rank test. Univariate Cox analysis was performed to determine significant factors for multivariate analysis. RESULTS: The majority of tumors [20 (51 %)] were moderate grade, T1/T2 [20 (51 %)], ampullary adenocarcinomas [18 (46 %)]. Mean hospital stay was 14 ± 8 days. The mean number of nodes removed was 13.9 ± 6.9, while mean number of positive nodes was 1 ± 1.7. Expected 5-year overall survival and relapse-free survival were 38 and 48 %, respectively. Overall 5-year survival was significantly different with respect to nodal involvement, i.e., 47 vs. 28 % (P = 0.018). On univariate analysis, nodal involvement was the only factor associated with an increased risk of death (P = 0.02, hazard ratio [HR] 2.9, confidence interval [CI] 1.1-7.8). CONCLUSION: Low-volume centers are an acceptable alternate to high-volume centers for performing pancreaticoduodenal resection in carefully selected patients. Efforts should be directed at developing specialized hepatobiliary centers in developing countries.

Radical surgical management of periampullary duodenal adenocarcinoma: a single institution experience.

OBJECTIVE: To share a single-centre experience with radical resection of adenocarcinoma of the second part of duodenum. METHODS: The retrospective review was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, and comprised data of patients who underwent pancreaticoduodenal resection for duodenal adenocarcinoma from January 1999 to December 2012. Patient characteristics and histopathological variables were assessed. Post-op complications, median disease-free span and overall survival were assessed. Expected 5-year disease-free and overall survival were calculated using Kaplan Meier curves. RESULTS: Of the 12 patients whose records were included, 8 (66.6%) were men and 4 (33.33%) were women. Overall median age was 55 years (range: 38-70 years). Jaundice was the predominant symptom in 9 (75%) patients. Five complications were observed during the post-operative period. Median disease-free and overall survival was 14.5 (0-140) and 17.5 (1-140) months respectively. Expected 5-year disease-free and overall survival were 56% and 21% respectively. Patients who survived >24 months had underlying well differentiated tumours, negative surgical margins, absence of perineural invasion and pancreatic involvement. CONCLUSION: Peri-ampullary duodenal adenocarcinoma is a rare malignancy. In selected patients, pancreatic oduodenectomy produces acceptable results.

Precontoured anatomical plates new era in the complex tibail plateau fractures fixation.

OBJECTIVE: Functional outcome of Intraarticular Tibial Plateau Fractures fixed with precontoured anatomical plates using Knee Society Score. METHODS: Observational study with retrospective review of collected data. Patient's demography, mechanism of injury, schatzker's classification includingtype IV, V and VI. All patients underwent screw and plate fixation using two incision technique with pre-contoured anatomical plates and intercondylar lag screws where indicated. Passive range of motion exercises started at 2 weeks. Postoperative knee pain, range of motion and stiffness were recorded at followup 3 and 4 months. Mean±SD were calculated for quantitative variables and qualitative variables were presented with frequency and percentages. The association of outcome (Knee Society Score) with gender, age and Schatzker's type was evaluated by applying Fisher's Exact test considering p-value <0.05 as significant. RESULTS: Twenty-five patients were included in study. 20 patients were available and 05 lost to follow up. 16 were males and 4 females out of 20 patients. Average age is 36.2±12.89 years. All patients sustained injuries after RTA. 5 patients had postoperative knee pain while remaining were pain free. Average flexion was 123.8 with (SD 8.88)range of 105 to 135 degree. Average extension was 3.15 with (SD 2.41) range of 0 to 8 degress. 4 patients developed stiffness of knee. 2 patients symptomatic implant. All fractures healed at follow up at 4 months. According to Knee Society score (SD 7.65) 14 cases scored as good, 4 cases scored fair and 2 cases scored poor. There was no association of knee score was found with gender (p=0.493) but significant association of knee score was found with age (p=0.007) and Schatzker's type (p=0.028). CONCLUSIONS: Tibial plateau fractures can be effectively treated by anatomical reduction and absolute fixation using pre-contoured anatomical plates. Functional outcome calculated by Knee Society score is better in young patients. With appropriate surgical techniques and early post-operative rehabilitation, good functional results can be achieved.

Malignant phyllodes tumour of the breast.

BACKGROUND: Malignant Phyllodes Tumour (MPT) is considered to be a rare disease of the breast. The most frequent clinical presentation of a MPT is a rapidly growing breast lump. METHODS: Consecutive cases of MPT registered between Jan 1, 1995 and Dec 31, 2012 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, were reviewed, to obtain information on age, tumour size, treatment given, disease-free survival, and overall survival. Disease-free survival was computed between the dates of surgery and recurrence, whereas, the overall survival time between the dates of diagnosis and last contact, both in months. RESULTS: A total of 101 cases of Phyllodes tumour were recorded. These included: malignant tumours (42) benign (27), and borderline (32). Malignant Phyllodes tumours (42 cases) were studied further and 41 included for additional analysis. The mean age of the women in the study was 40.3 +/- 12.5 (22-72 years). Of the 33 patients who were disease-free after surgery, 15 had a recurrence, whereas, 18 did not have a recurrence. In those who had surgery alone versus those who received radiation treatment in addition to surgery, the median disease-free survival was 117 and 44.2 months, respectively. The mean overall survival time was 33.7 months. CONCLUSION: In this study, patients presented at a younger age than in other studies. Further exploration into molecular, biologic, geographic, and socioeconomic factors is needed to clearly understand the epidemiology of this disease in our population.

Prevalence and Risk Factors of Low Anterior Resection Syndrome in Epithelial Ovarian Cancer Surgery.

Background In this study, we aimed to determine the prevalence and risk factors of low anterior resection syndrome (LARS) in epithelial ovarian cancer (EOC) surgery. Methodology A descriptive cross-sectional study was conducted at the Gynecologic Oncology Section of the Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. Using non-probability consecutive sampling technique, all patients who underwent cytoreductive surgery involving low anterior resection for EOC between January 2016 and January 2021 were included. Patients were assessed for LARS symptoms using the LARS score, along with its risk factors. Descriptive statistics, that is, continuous variables were expressed as the median and interquartile range, while categorical variables were expressed as frequencies and percentages. The LARS score was categorized according to a two-tier model with "no or minor LARS" and "major LARS." Univariate analyses were performed by the chi-square tests providing odds ratios and 95% confidence intervals to identify risk factors for major LARS. Results Overall, 95% of cases had LARS scores that fell in "no or minor LARS," while only 5% of cases had "major LARS." Univariate analyses relieved no statistically significant association between the occurrence of major LARS and any of the risk factors. Conclusions The prevalence of LARS was 5%, and no risk factors were associated with major LARS in our study population.